Opioid-related problems in Baltic States and Poland: has the turning point come?

Background

EMCDDA data show that NPS opioids are emerging. The opioid epidemic in the US indicates that the opioid problem might return to European countries despite the fact that the problem in America evolved from non-medical use of opioid drugs. Considering the record-breaking poppy crops in Afghanistan in 2017, according to the World Drug Report 2018, one might expect increased supply of heroin across the European markets.

Methods

The aim of the study is to analyse differences and similarities of opioid-related problems in Lithuania (LT), Latvia (LV), Estonia (EE) as well as Poland (PL) in terms of supply and demand by drawing on the latest data with particular emphasis placed on NPS opioids. The analysis attaches particular importance to new trends in opioids problem, which might impact public health. The analysis reviews the existing data, which were later discussed an expert meeting.

Results

As regards heroin it is worth noting that in 2017 small quantities of heroin were seized in PL (2,49 kg), EE (0.008kg) LV (0.2kg) and LT (3,9 kg). In LV heroin had been replaced by other substances NPS opioid and opioids medicines for several years. In LT, there was a new trend in 2017 and 2016, heroin was replaced by carfentanil. In PL, NPS opioids have been used for a few years especially in Krakow city where there was a shortage of heroin. In EE, fentanyl has been available on the Estonian drug market since 2002 when heroin was replaced by new opioids.

The prevalence of opioids use in the general population in the countries under study is low. However, treatment demand data show that, except for PL (6%), half or more first-time drug treatment patients are opioids users (LV 50%, LT57%, EE 93% in 2017). Opioids-related deaths still remain the primary cause of fatal drug overdoses (LV 54% of all cases in 2017, LT 55% 2017, PL - Warsaw 60% 2016, EE 91% 2016). EE tops the chart with 132 opioid-induced deaths per million inhabitants (2016 data). However drug related deaths have decreased drastically in EE: from 2017 110 cases to 34 (till November 2018). The reason behind this has been a shortage of fentanyl on the EE drug market as well as increased availability of naloxone. The analysis results demonstrate that shortages in heroin supplies (LT, LV, Krakow in PL) cause that drug users resort to more dangerous opioids of the fentanils group.

Conclusions

In LT, LV and PL a shortage of heroin was replaced by other substances, mostly NPS opioids (LT, LV) and NPS (PL). Taking into account the experience of EE, which responded to the opioids problem with an extensive naloxone program along with the activities aimed at reducing supply against opioids trafficking may be a crucial approach for implementing an effective response to the problem of opioids. The availability of other harm reduction measures such as safe injecting rooms is needed in the future. As fentanyl potency is very different, the improved situation could change quickly if stronger version of fentanyl emerges on the market.